HomeMy WebLinkAboutGas Street Cut Permits 66 Sharon Drive ` TOWN OF SOUTH WINDSOR INSIPECTION REPORT
Permit No. 3806 Co tzza<C� 'or YANT� E< �5
Location 0066 SHARON DRIVEg:3112 ,rtOgEC�: IILL RD
Type Work GAS :..;
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Permit No. 3806 Town of South Windsor, CT
Date 07/28/2004 "' ''' t: Street Excavation Permit
Expiration Date 07/28/2005
Descri INSTALL H6
p: GAS SERVIC„L�``" F
Applicant 41IM
yr •4' <`t�ac a<C•'a��
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Name YANKEE GAS (9y ` SHARON LVE
Addr. 112 PROSPECT HI <L;'•, qC:#".>`z""`• :2Frzt;
E. WINDSOR CT 0'60"
,ert"
Phone (860)292 2242
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Applicant agrees; C'6-if4•;4f `k�<`th o . Wind` e' a'o`''
�dX�:«tki ixnt of bond
required and to rei nk3t Y`ae., a u '' }
1 x z ti r f ^>< 3 p qh s e s
incurred ' "�"b the Towi3oa`Y p� S3Y�lc,��sx%:; tnn�ectiEin with this
permit and that appl` gazit y a#�i " r- '. by.»tue rules and
iM
regulations for ermts as ba.G iif
P '> G1g 'TCs } Sc :li G}: nds'or s Street
Cut Permit Manual
': �.
* * PERMIT TO"`i:-B <Y
Issued b ""� _" .. . ,. 1.
Date Completed ___ ............ Inspected By —
3
r%Jm J 1 mr-r— I r-AUAVA1ION PERMIT ,4ro
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm
Phone No. � 6 D 9;2,-���(�'
Address of Firm fr!2,o S +P,k-CAV
Location of proposed work �p
Describe fully nature of permit requested .) C k-V`8 ric—
Starting date Q C 7- _ Approx. time for completion y
Call Before You Dig No.2,�C 0 1 .5 - � Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
^ No.cuts
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
1 No. Cuts
r vd S' A ,l
-Size of Patch(s)
C. L
Final Billing
Q N o Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting Date
the Police Dept.and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:_--' Date:
Title: V:7/ �. �„(f Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES